Comparison of the psychometric characteristics of the functional independence measure, 5 item Barthel index, and 10 item Barthel index in patients with stroke.

OBJECTIVES: To compare the reliability, validity, and responsiveness of the motor subscale of the functional independence measure (FIM), the original 10 item Barthel index (BI), and the 5 item short form BI (BI-5) in inpatients with stroke receiving rehabilitation. METHODS: 118 inpatients with stroke at a rehabilitation unit participated in the study. The patients were tested with the FIM motor subscale and original BI at admission to the rehabilitation ward and before discharge from the hospital. The distribution, internal consistency, concurrent validity, and responsiveness of each measure were examined. RESULTS: The BI and FIM motor subscale showed acceptable distribution, high internal consistency (alpha coefficient > or = 0.84), high concurrent validity (Spearman's correlation coefficient, r(s) > or = 0.92, intraclass correlation coefficient (ICC) > or = 0.83), and high responsiveness (standardised response mean > or = 1.2, p < 0.001). The BI-5 exhibited a notable floor effect at admission but this was not found at discharge. The BI-5 showed acceptable internal consistency at admission and discharge (alpha coefficient > or = 0.71). The concurrent validity of the BI-5 was poor to fair at admission (r(s) = 0.74, ICC < or = 0.55) but was good at discharge (r(s) > or = 0.92, ICC > or = 0.74). It is noted that the responsiveness of the BI-5 was as high as that of the BI and the FIM motor subscale. CONCLUSIONS: The results showed that the BI and FIM motor subscale had very acceptable and similar psychometric characteristics. The BI-5 appeared to have limited discriminative ability at admission, particularly for patients with severe disability; otherwise the BI-5 had very adequate psychometric properties. These results may provide information useful in the selection of activities of daily living measures for both clinicians and researchers.

Psychometric characteristics of the Barthel activities of daily living index in stroke patients.

BACKGROUND AND PURPOSE: Although the Barthel activities of daily living (ADL) index (BI) is widely used to measure disability in Taiwan, the usage of the BI has not been scientifically justified. This study examined the reliability, validity, and responsiveness of the BI in a cohort of stroke patients who were followed for half a year after stroke. METHODS: One hundred and twenty-one patients were assessed using the BI at 14, 30, 90, and 180 days after stroke (DAS). Reliability of the BI was determined by estimation of inter-rater agreement and internal consistency. Validity of the BI was determined by examining convergent construct validity and predictive validity. Responsiveness was determined using effect size and t-statistics calculations. RESULTS: There was moderate to excellent agreement between raters for individual items (kappa value range, 0.53-0.94) and total score (ICC = 0.94). An excellent internal consistency was found within the BI at four DAS points (alpha value range, 0.89-0.92). The BI scores closely correlated with scores of the Fugl-Meyer motor assessment (measuring impairment) and the Berg balance scale (measuring balance) (Pearson's r > or = 0.78, p < 0.0001). The Frenchay activities index (measuring instrumental ADL) at 180 DAS showed moderate correlation with the BI scores obtained at 14, 30, and 90 DAS (Pearson's r > or = 0.59, p < 0.0001). The effect size d, standardized response mean, t-statistics, and p-values showed that the BI was moderately to highly responsive at each stage of stroke recovery except the late stage (90-180 DAS). CONCLUSION: This study has demonstrated that the BI is a useful instrument with high inter-rater reliability, internal consistency, convergent and predictive validity, and adequate responsiveness in assessing ADL functions in stroke patients in Taiwan.

Validity and responsiveness of the rivermead mobility index in stroke patients.

The Rivermead Mobility Index is used to measure mobility in patients with head injury or stroke. The purpose of the study was to examine construct validity, predictive validity, and the responsiveness of the Rivermead Mobility Index in stroke patients. Thirty-eight stroke inpatients participated in the study. The Rivermead Mobility Index, the Barthel Index, and the Berg Balance Scale were administered at admission to the rehabilitation ward and at discharge. The results showed that the Rivermead Mobility Index fulfilled the Guttman scaling criteria (coefficients of reproducibility > 0.9, coefficients of scalability > 0.7). The Rivermead Mobility Index scores were highly correlated with the Barthel Index scores (Spearman rs > 0.6) and the Berg Balance Scale scores (Spearman rs > = 0.8, all ps < 0.001). The Rivermead Mobility Index score at admission was closely correlated with the Barthel Index score at discharge (Spearman r = 0.77, p < 0.001). About 76% (29) of the subjects improved by more than 3 Rivermead Mobility Index points (median = 5) during their stay. The relationship between the change in score of the Rivermead Mobility Index and the Barthel Index was fair (Spearman r = 0.6, p < 0.001). These results indicate that the Rivermead Mobility Index is valid and sensitive to change over time. It is therefore a useful scale for the assessment of mobility in stroke patients.

Evaluation of stroke patients with the extended activities of daily living scale in Taiwan.

PURPOSE: This study examined the construct validity of the Nottingham Extended Activities of Daily Living scale (EADL) in stroke patients in Taiwan. METHODS: The EADL and the Barthel Index were administered via telephone interview. Minor revisions were made for the EADL to reflect cultural differences and the recommendations of two previous studies on the use of EADL. One hundred and fifty three stroke patients from the community participated in the study. RESULTS: Two items, 'make hot snack' and 'write letters', were deleted from the EADL because they appeared to be of little discriminative value. The results suggest that a changed hierarchical order was present among the domestic and leisure subscales. All of the subscales, then, fulfilled the Guttman scaling criteria (coefficient of reproducibility > 0.9, coefficient of scalability > 0.6). The scores of the revised EADL were significantly related to age and the Barthel Index scores (Spearman correlation coefficients = -0.41 and 0.69, respectively, p < 0.001). There was no significant difference between the overall scores of men and women (median = 10, 10, respectively, Mann-Whitney U test, p = 0.67). CONCLUSION: These data support the validity of the EADL with minor modifications in the evaluation of the functional performance in stroke patients in Taiwan and confirm it to be a useful outcome measure in stroke research.

A cross-validation of the comprehensive assessment of activities of daily living after stroke.

This study aimed to determine whether the Frenchay Activities Index and the Barthel Index assess different factors in stroke patients who survive for more than one year. The Frenchay Activities Index and the Barthel Index were administered via telephone interview. One hundred and twenty-four patients from the community participated in the study. All items of the Barthel Index and the Frenchay Activities Index, except reading books, were included in a factor analysis to determine the underlying constructs of the items. Four factors were found. One factor comprised all items from the Barthel Index and one item from the Frenchay Activities Index. The rest of the Frenchay Activities Index items loaded on three other factors. The combined scores, using simple transformation, had satisfactory distributions. The results support the hypothesis that the Frenchay Activities Index and the Barthel Index assess different factors in stroke patients who survive for more than one year. The Barthel Index score and the Frenchay Activities Index score could be combined to assess the entire range of activities of daily living functions in stroke.

Inter-rater reliability and validity of the action research arm test in stroke patients.

BACKGROUND AND PURPOSE: The Action Research arm test (ARAT) was constructed for assessing recovery of upper extremity function after cortical injury. The objective of the study was to verify the inter-rater reliability and validity of the ARAT in stroke patients. METHODS: 50 stroke patients participated in the study. For the purpose of inter-rater study, the ARAT was administered by three experienced raters on each patient within a 3-day period. Validity was assessed by comparing the patients' scores on the ARAT with those obtained for the other well-validated measurements evaluating upper extremity motor impairment and disability. RESULTS: Intra-class correlation coefficient (ICC) for the total score was 0.98 indicating very high inter-rater reliability. ICCs were also very high in each of the subscales. The score of the ARAT was closely correlated with that of the upper extremity part of the motor assessment scale, the arm sub-score of the motricity index and the upper extremity movements of the modified motor assessment chart (Pearson r = 0.96, 0.87 and 0.94, respectively). CONCLUSION: The preliminary results of this study support the value of the ARAT for measuring recovery of arm-hand function in stroke patients.